Food adulteration and consumer awareness in Dhaka City, 1995-2011.

We conducted this study to investigate the magnitude of food adulteration during 1995-2011 and consumer awareness in Dhaka city. We reviewed results of food sample testing by Public Health Food Laboratory of Dhaka City Corporation, Bangladesh Standards and Testing Institution, Consumers Association of Bangladesh publications, reports from lay press, including those on mobile magistrate court operations. We conducted a cross-sectional survey among 96 residents of Dhaka city, using a structured questionnaire in 2006. The overall proportion of food samples adulterated decreased during 2001-2005, and 40-54% of daily-consumed food was adulterated during 1995-2011. More than 35 food items were commonly adulterated. Consumers considered expiry date and quality or freshness as the best criteria while buying packaged and open food items respectively; only 11 (12%) respondents considered approval of regulatory authority for buying packaged food items. More than half of the food consumed in Dhaka city is adulterated, which warrants actions by the Government, the industry, and the consumers.


INTRODUCTION
Food safety, an important global public health issue to ensure sound health, refers to addressing "all those hazards, whether chronic or acute, that may make food injurious to the health of the consumer" (1). Important food hazards include microbial hazards, pesticide residues, misuse of additives, chemical contaminants, including biological toxins and adulteration. Although microbiological contamination and chemical hazards have received most attention, it is recognized that food adulteration and food fraud should not be neglected considering their role in public health (2). Food adulteration includes various forms of practices, such as mixing, substituting, concealing the quality of food by mislabelling, putting up decomposed or expired food, and adding toxic substances (3). It is an age-old problem that affects people at all societal strata. The consequences of food adulteration are two-fold for the consumers: the economic loss by paying more for lower-quality food items and the

Food Adulteration and Consumer Awareness in Dhaka City, 1995-2011
and print media featured reports on horrendous food adulteration practices. Sixty-four percent sellers/producers in a study in Bangladesh reported using chemicals in their products, although 74% were aware that mixing chemicals with food was harmful to health. They used harmful chemicals to make the products more lucrative, increase shelflife, substitute for unavailable natural raw materials, and reduce price of the goods (8). Recently, a growing concern has been the use of prohibited food colours, such as textile dyes in many foods to increase acceptability of food (9). Nearly half of the samples of sweetmeats and confectionary items contained non-permitted food colours in Pakistan (10). In India, consumption of non-permitted textile colours or abuse of colours were attributed to reported foodborne illnesses (11).
There are several laws and regulations in our country to ensure the standard of food manufacture and sale (Box 1) (7,12). Enforcement of food laws, rules and regulations in Bangladesh is a shared responsibility of different ministries and their concerned departments. The food samples are analyzed at different government food laboratories. The Consumer Right Protection Ordinance 2008 was passed in the Parliament on 1 April 2009.
Studies conducted on food safety mostly focus on microbiological contamination. There is limited published data on the temporal trend and magnitude of food adulteration and on consumers' knowledge, attitude, and practices regarding food adulteration in Bangladesh. These data would help formulate preventive and control measures to reduce food adulteration and ensure the safety and integrity of food the citizens buy and consume. We conducted this study to describe the magnitude of food adulteration from 1995 to 2011 in Dhaka city; determine whether raids by the mobile food court intensifying in 2005 had any impact on food adulteration; identify commonly-adulterated food items and common adulterants; and determine food adulteration-related knowledge, attitude, and practice of consumers in Dhaka city.

MATERIALS AND METHODS
We conducted this exploratory study in Dhaka, Bangladesh. We collected both secondary and primary data during 2006-2013 to address our study objectives.  , 1983and Marine Fisheries Rules, 1983The Special Powers Act, 1974Agricultural Products Market Act, 1950(revised in 1985 nance, 1959 and The Bangladesh Pure Food Rules, 1967. All the tests are not done as per standard due to lack of equipment. A food sample is reported as adulterated if it does not conform to the standard. The PHFL of DCC cannot detect the nature and quantity of chemicals, artificial food colours, or quantify the presence of permitted food additives due to lack of equipment. The sanitary inspectors can suspect what substances are added to it from their experience. If a food item is found pure by testing on several occasions, it is assumed that it is not adulterated, and sample of that food item is not tested for some time. We also reviewed lay press reports on food adulteration during 1995-2011. We collected information from the BSTI on food sample testing results during 2005-2006 but details were unavailable due to confidentiality of the reports. We reviewed issues of 'Consumer Voice', the official bimonthly publication of Consumers Association of Bangladesh (CAB). We also reviewed the reports on mobile food court operations collected from a metropolitan magistrate of the Chief Metropolitan Magistrate (CMM) court conducting mobile food court raids.
We identified commonly-adulterated food items and common adulterants by reviewing the food sample testing results of the PHFL of DCC and reports on food adulteration published in the Bangla newspaper 'The Daily Ittefaq' and the English newspaper 'The Daily Star' in 2005. We collected clippings of newspaper reports from the Consumer Association of Bangladesh office where records of all news on food adulteration and other consumerrelated issues published in the newspapers are regularly maintained. The reports in the newspapers are based on information collected from different stakeholders.
We conducted a cross-sectional survey in eight DCC Kutcha bazaars (kitchen markets) among 96 adult male and female respondents during November 2006. As data on the proportion of consumers having some knowledge on food adulteration were unavailable from published literature, our estimated sample-size was 96 for the cross-sectional survey assuming that 50% of our respondents will have knowledge about food adulteration with 95% confidence level and allowing 10% error. We included respondents residing in Dhaka for at least 2 years and not involved in food trade. From a list of kutcha bazaars (kitchen markets) in eight zones of DCC, we selected one kutcha bazaar from each zone by lottery. In each kutcha bazaar, we randomly selected the first consumer and, thereafter, every 5th consumer according to inclusion criteria till 12 consumers were interviewed. We administered a standardized questionnaire outside one of the entrances of the markets. We collected information on sociodemographics and food adulterationrelated knowledge, attitude, and practices.
We conducted informal discussions with key stakeholders engaged in public health, including a public food analyst, a sanitary inspector, a metropolitan magistrate, and a staff at one of the DCC offices to explore relevant aspects on food adulteration.

Ethics
We secured official permission from the Chief Health Officer of DCC and the Director General of BSTI for obtaining food sample testing results. We did not collect any brand name of the tested food samples for ethical concern. We obtained informed verbal consent from the respondents before conducting the interviews. The study was approved by the Ethical Review Board of James P. Grant School of Public Health, BRAC University, Bangladesh, in collaboration with icddr,b.

During 2001-2005
The majority of the food samples collected by the sanitary inspectors from different parts of Dhaka city and tested at the PHFL of DCC were found to be adulterated (Table 1).
Of the tested food samples, 100% of samples of the popular sweetmeat Rosogolla was found to be adulterated while most of the other sweetmeats, including Sandesh, Chhana, Kheer, and Malai were also adulterated at different levels (data not shown). Dalda/Banaspati (hydrogenated vegetable oil) is another food item persistently found adulterated (100% in 2001, 2003, and 2004; 97% in 2002 and 2005).Twenty-eight food items were not adulter-ated during 2001-2005, and 12 of these items were not tested at least for one year thereafter. No milk powder, cream, maida (wheat flour), fruit juice/ squash, pickle, coriander seed, bread, cake, biscuit, sugar, honey, lozenge or jorda (smokeless tobacco) was found adulterated by the PHFL in 2005. Nine food items were not tested in the following year even after these were found to be adulterated during 2001-2004. The number of food samples tested each year varied from a single sample to 232 samples of the same food item.
According to the PHFL officials, conforming to a test parameter does not necessarily ensure purity of a food item. The manufacturers can manipulate by adding artificial ingredients to food items so that the test results are within acceptable limits. For example, in pasteurized milk, instead of milk protein, they can add cheaper vegetable protein, like soy protein and get test result within the expected limit.
In 2005, 12 brands of juices from 8 companies were collected from different markets of Dhaka by CAB and tested at BSTI as per Bangladesh Standards where 11 (92%) of the 12 samples had BSTI certification mark, although 8 (73%) of them failed to conform to the standard. Two orange juices had no fruit juice at all, and two juices had the preservative sulphur dioxide at more than the permitted level of 10 ppm. One brand of mango juice was substandard and did not have BSTI certification mark. The labels on the package also lacked information on percentage of the ingredients (58%), production date (25%), and expiry date (17%) (13).
Only 8 (13%) out of 62 brands of salt collected from different markets across the country by BSTI and tested at the laboratory conformed to BSTI standard (Box 2) (14). During 2005-2006, a total of 135 samples of mineral water, iodized salt, juice, soybean oil, mustard oil, and banaspati/ghee were collected from the market and tested. Among those, 90 (67%) did not conform to the Bangladesh Standard (BDS), and BSTI took actions, such as issuing of show-cause notice, penalty, and cancellation of license.

During 2001-2005
There was a statistically significant decreasing trend in the proportion of food samples that tested positive for adulteration in Dhaka city during 2001-2005 (chi-square for linear trend 39.5, p<0.001) (Figure).

During 1995-2011
According to the National Food Safety Laboratory under the Institute of Public Health, Bangladesh, 40-54% of daily consumed food was adulterated during 1995-2011 (15). He also mentioned that the mobile court activities were sometimes hampered by non-cooperation of the field workers of BSTI and DCC. A staff at one of the DCC offices stated:

Mobile court operation and its effect on food adulteration situation
Do you think food adulteration has decreased? It has decreased only on the surface; things go on underneath. As long as corruption prevails in our country, it will not decrease. The dishonest traders get the information of mobile court raid beforehand through mobile phone.

Adulterated food items and adulterants used
According to PHFL of DCC, 39 food items were adulterated during January 2001 to December 2005 (Box 3). Traders used various adulterants in different food items (Table 2 and Table 3) (16,17).

Consumer awareness (knowledge, attitude, and practice)
The majority of the respondents were male (82%) ( Table 4). Half of the respondents (47/94) spent more than 41% of their monthly income on food. Stale or rotten food was the most commonlymentioned form of food adulteration by the consumers (Table 5). The majority (85%) of the respondents knew that there is a law in the country that deals with food adulteration; among them, 25 (33%) thought that the existing law and enforcement was sufficient. More than half of the respondents (53, 55%) opined that food adulteration had decreased. Only 26 (28%) respondents Milk and milk products: Food grains, cereals, and cereal products: correctly knew how to test salt by adding it to rice and observing change in colour to purple after adding lemon juice to it ( Table 6). The majority of the respondents (91, 95%) strongly agreed that food adulteration has harmful effects on health.   (Table 7). Of the respondents, 89 (93%) stated that they stopped/would stop consuming a food item if they had learnt that it was adulterated, four (4%) would continue to consume it while two (2%) would continue to consume since they had no alternative. If they suspected any food item to be adulterated while buying, 87 (91%) mentioned that they bought pure food (i.e. supposedly unadulterated) from another seller. Only 9 (9%) respondents complained it to the seller and bought pure food from another seller.

DISCUSSION
This exploratory study assessed the magnitude and temporal trend of food adulteration in Dhaka city as well as consumers' knowledge, attitude, and practice relating to it. The results of the study revealed a significant decreasing trend in the proportion of lab-oratory-confirmed adulterated food samples during [2001][2002][2003][2004][2005]. However, there is no room for complacency as the extent of food adulteration remained 40-54% during 1995-2011. Nevertheless, our findings further suggest that there was substantial variation in the collected food items and the number of samples tested each year. The lack of systematic procedure for random sampling may result in potentially biased estimation of food adulteration.
Adulteration of particular food items is still rampant. Rosogolla, one of the most popular sweetmeats in Bengali culture, has been consistently found to be 100% adulterated. A comparative study on the quality of laboratory-made and local market rosogolla conducted in Mymensingh also found the laboratory-made rosogolla to be of better quality than ones in the market in terms of physical and chemical parameters. Rosogolla from the market having higher total solids and carbohydrate content with lower protein and fat level might have been due to adulteration by addition of skimmed milk chhana, wheat flour, and high level of sugar (18). Ninety percent of randomly-collected samples of sweetmeats from different parts of Bangladesh were also found adulterated in 2002 (6); 97% of randomly-collected 400 samples of sweetmeats from Dhaka in 2003 were adulterated, and 91% samples had less than 10% milk fat which should have been at least 10% as per Bangladesh standard laid down by BSTI and The Bangladesh Pure Food Rules, 1967 (19). While no juice, fruit syrup, or fruit squash was found adulterated in DCC testing in 2005, twothirds of the mango and orange juice samples collected by CAB and tested at BSTI were found not conforming to the BSTI standard, although the majority of the juices had BSTI certification mark. It is notable that, in the same year, the majority of the tested brands of iodized salt did not conform to BSTI standard, although half of those had the iodine content within BSTI requirements. Manufacturers do not always maintain the quality of marketed food products after receiving the certification mark from BSTI that may be inten-tional for more profit or due to ignorance. Since the packaged food items are produced and marketed throughout the country, quality control of marketed food products clearly warrants more stringent monitoring.
Although mobile court raids against food adulteration were not uncommon in Dhaka city, they attained momentum in 2005 when anti-adulteration drives were intensified. We found that the proportion of adulterated food samples reduced significantly in 2006 compared to that in 2005. This may be attributed to the intensified activities of the mobile food court. It was also affirmed by one of the metropolitan magistrates conducting the mobile court. Moreover, amendment of the age-old Pure Food Ordinance and media attention with reporters accompanying the magistrates and reporting revelation of horrendous practices may also have role in it. Contrary to this, one of the staff members at a DCC office claimed that this success was only superficial. The magistrate also mentioned occasional non-cooperation from the field workers of DCC and BSTI during the raids. The allegation of the alliance of dishonest traders with administrative and law-enforcing agencies has long been identified as one of the obstacles in curbing food adulteration (9,20). Nevertheless, anti-adulteration drive by the mobile court should be regularly conducted to curb food adulteration.
A number of food items were not found to be adulterated in the DCC food testing, although unhygienic conditions were found during manufacturing some of the food items, rendering them prone to microbiological contamination. Furthermore, anecdotes of mobile food court raids showed vermicellis being prepared in extremely unhygienic condition, keeping broom and sweaty shirts over them with flies buzzing around (21). The likely explanation for often doubtful results from DCC laboratory is the bias in sampling or technological limitations. Different colouring agents and textile dyes were extensively used in a variety of food items but detection of the nature and level of the colouring agents has not been possible due to the lack of advanced laboratory facilities. A study in India found synthetic food colour exceeding the statutory limits in the majority of food items and non-permitted colours in some of the foods sold at kiosks (22). Developing laboratory capacity for essential chemical analysis would enable to detect the nature and extent of different colouring agents and textile dyes.
Chemicals, such as calcium carbide, formalin, sodium cyclamate, DDT, and urea, were widely used. Formalin was detected in 9 out of 11 fishes tested in the Pharmaceutical   (12) 16 (16) Median (range) duration of stay in Dhaka (years) 20 (2-76) Median (range) monthly household income (Taka) * 15,000 (3,000-150,000) Median (range) percentage of income spent on food * 41.64 (10-83) * Two respondents did not know commonly known as 'mobil', was found to be mixed with edible oil and used for frying different food items. This finding is comparable to the findings of the Department of Environment where PCB was detected in popular snacks, such as peaju, jilapi, puri, and potato chops sold in roadside shops and in packaged chanachur sold in stores (26). Traces of PCB were also found in blood sample of some people, although the safety level is not determined yet.
Although food adulteration received considerable media attention, the consumers in our study lacked knowledge on what comprises food adulteration, commonly adulterated food items, and the adulterants used. A survey on awareness of consumer right found that most of the consumers knew about toxic colours and chemicals in fruits and vegetables; 85% study participants knew that there exist laws in the country that dealt with food adulteration but 67% of them opined that the existing law and enforcement was insufficient to curb the problem (27). In contrast, more than half of the respondents in this study thought that food adulteration has decreased following mobile court raids while one-third thought it has remained unchanged. The practice of considering BSTI approval was substantially low among our respondents. Consumers should be made more aware of the quality of the food they should consider while buying different food items.

Limitations
This study has several limitations. The magnitude of food adulteration was ascertained by review of the food testing results of DCC public health food laboratory and review of CAB publications. Since the food samples are not randomly collected, there is a chance of potential bias. Due to sensitivity of the problem and, hence, inaccessibility to the details of the food testing reports, a more comprehensive scenario of adulteration could not be assessed. Although there are multiple laboratories for food analysis, results from a single laboratory were reviewed for reasons of accessibility and time constraints. The survey on consumer awareness was conducted in kitchen markets under Dhaka City Corporation. It is assumed that the people who buy food items from these markets have better income than those who do not go there. However, it is generally assumed that people of lower economic group, who struggle for their subsistence, are not concerned with the safety and quality of food they consume. Moreover, there are many small bazaars in each locality from where many consumers buy their food items. Some of the markets had more  (24) 18 (19) 16 (17) 15 (16) 12 (13) 1 (1) 9 (9) 43 (45) 33 (34) 31 (32) 19 (20) 18 (19) 15 (16) 10 (10) 9 (9) 8 (8) 7 (7) 6 (6) 6 (6) 6 (6) 3 (3) 3 (3) 2 (2) 1 (1) 1 (1) 4 (4) 40 (42) 22 (23) 21 (22) 17 (18) 4 (4) 2 (2) 1 (1) 1 (1) 1 (1) 13 (14) * Multiple responses; † Two respondents did not respond; ‡ One respondent did not respond; Percentages do not sum up to 100 than one entrance, and it was not possible to cover all the entrances. As a result, the knowledge, attitude, and practice of the consumers interviewed may not represent that of Dhaka city dwellers and need further large-scale survey.

Conclusions
The extent of food adulteration was high enough to warrant further action to control the situation. Collection procedure of food samples has the potential for biased estimation and, therefore, undermines the validity of the extent. A systematic procedure of random food sample collection incorporated in a surveillance for food adulteration could give an accurate picture of the situation. The extensive use of different chemicals and dyes in food calls for appropriate measures. The majority of the consumers lack proper knowledge, attitude, and practices relating to food adulteration. Publicizing the newly-passed consumer protection law, other existing food adulteration-related laws, and different aspects of food adulteration via mass media could play a crucial role in raising consumer awareness. Stringent enforcement of the forthcoming unified food law 'Safe Food Act 2013' by the Government would substantially decrease food adulteration in the country (28). Drives by mobile magistrate court were found to be effective and should be re-started in collaboration with the media that can publicize the results of the drive for building awareness. Epidemiologic and toxicologic studies should be undertaken for risk assessment of different synthetic food colours and chemicals used in food items to better understand short-term and long-term adverse effects on health, nutrition, and intellectual performances. Studies on epigenetics should also be performed to investigate the association of food adulteration and different types of cancer.  (27) 15 (16) 12 (13) 9 (9) 7 (7) 4 (4) * Multiple responses; Percentages do not sum up to 100